Persistence of Symptoms After Discharge of Patients Hospitalized Due to COVID-19

Many patients who had coronavirus disease 2019 (COVID-19) had at least one symptom that persisted after recovery from the acute phase. Our purpose was to review the empirical evidence on symptom prevalence, complications, and management of patients with long COVID. We systematically reviewed the literature on the clinical manifestations of long COVID-19, defined by the persistence of symptoms beyond the acute phase of infection. Bibliographic searches in PubMed and Google Scholar were conducted to retrieve relevant studies on confirmed patients with long COVID that were published prior to August 30, 2021. The most common persistent symptoms were fatigue, cough, dyspnea, chest pains, chest tightness, joint pain, muscle pain, loss of taste or smell, hair loss, sleep difficulties, anxiety, and depression. Some of the less common persistent symptoms were skin rash, decreased appetite, sweating, inability to concentrate, and memory lapses. In addition to these general symptoms, some patients experienced dysfunctions of specific organs, mainly the lungs, heart, kidneys, and nervous system. A comprehensive understanding of the persistent clinical manifestations of COVID-19 can improve and facilitate patient management and referrals. Prompt rehabilitative care and targeted interventions of these patients may improve their recovery from physical, immune, and mental health symptoms.

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Utilizing Incident-Based Crime Data to Inform Strategic Interventions

Justice Research and Policy ◽

10.1177/1525107116674925 ◽

2016 ◽

Vol 17 (1) ◽

pp. 3-27

Author(s):

Jason Rydberg ◽

Rebecca Stone ◽

Edmund F. McGarrell

Keyword(s):

Reporting System ◽

Excess Risk ◽

Public Health Approach ◽

Least Squares Regression ◽

Crime Data ◽

Targeted Interventions ◽

Aggravated Assault ◽

System A ◽

High Crime ◽

Demographic Subgroups

A public health approach to violence prevention involves the empirical identification of groups and communities at the highest risk for violence to inform targeted interventions. We demonstrate the utility of complete incident-level crime data toward this end. Data for 32,056 unique incidents involving homicide, aggravated assault, and robbery were extracted from the 2013 Michigan Incident Crime Reporting system, a statewide National Incident-Based Reporting System (NIBRS) data system. Differential victimization rates were calculated across demographic subgroups and jurisdictions to identify patterns in risk. Two-stage least squares regression models were estimated to examine correlates of variation in excess risk. Analyses identified young Black males and females at relatively high risk for violent victimization, and that this risk was amplified within cities with disproportionately high crime rates. Multivariate models suggested concentrated disadvantage as the most stable correlate of variation in excess risk across Michigan cities and towns. The results highlight the importance of expanding NIBRS adoption and the deployment of focused interventions involving both short-term enforcement and long-term social reinvestment.

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Abstract 212: Acute Myocardial Infarction in the Acute Phase in Kawasaki Disease in Mexican Children.

Circulation ◽

10.1161/circ.131.suppl_2.212 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

William Sarmiento-Robles ◽

Luis M Garrido-Garcia

Keyword(s):

Myocardial Infarction ◽

Kawasaki Disease ◽

Acute Phase ◽

Delayed Diagnosis ◽

Clinical Manifestations ◽

Unknown Origin ◽

Z Score ◽

Laboratory Parameters ◽

Small Series ◽

Coronary Aneurysms

Background: Kawasaki disease (KD) is an acute febrile vasculitis of unknown origin. Despite treatment with intravenous immunoglobulin during the acute phase of the disease, up to 5% of those affected will develop coronary aneurysms predisposing them to thrombotic complications that could result in myocardial infarction (AMI). In Mexico there are few reports of ischemic complications secondary to KD. Objective: To describe the clinical features, the laboratory parameters, treatment used and the outcome of children who presented with myocardial infarction during the acute phase of KD in a third level facility in Mexico City Methods: From our Institutional Database of KD we search for children who presented AMI in the acute phase of the disease from August 1995 to August 2014. We analyzed gender, age, clinical manifestations, time from the onset of the symptoms to diagnosis, laboratory parameters, treatment used, and outcome in the acute phase of the disease. Results: Eight infants were diagnosed with AMI during the study period. The median age at diagnosis was 8 months (range 2 to 53 months). Seven patients were male (87.5%). The median from the onset of the clinical manifestations to diagnosis of KD was 22 days (range 4 to 26 days). All patients developed giant coronary aneurysms (median Z-score 18.98, with a range of Z-score from 11.58 - 27.70). An abnormal EKG and abnormal perfusion tests demonstrated the myocardial infarction in all cases. Two patients died in the acute phase of cardiogenic shock, one more patient died of dilated cardiomyopathy 12 months after coronary bypass surgery with an overall mortality of 62.5% of this group. Conclusions: AMI is a fatal complication of KD. In our small series it was associated with a delayed diagnosis of the disease and therefore the development of giant coronary aneurysms. Treatment of AMI in children after KD is a medical challenge with a poor prognosis in children.

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Leukocytes and Albumin in Canine Leishmaniasis

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.111869 ◽

2021 ◽

Vol 49 ◽

Author(s):

Társsila Mara Vieira Ferreira ◽

Alexandre Tavares Camelo Oliveira ◽

Victor Machado De Carvalho ◽

Ana Débora Nunes Pinheiro ◽

Thaíse Cristine Ferreira De Carvalho Sombra ◽

...

Keyword(s):

Inflammatory Response ◽

Acute Phase ◽

White Blood Cells ◽

Clinical Manifestations ◽

Canine Leishmaniasis ◽

Total Proteins ◽

Albumin Ratio ◽

Lymphocyte Ratio ◽

Cell Counts ◽

Healthy Dogs

Background: Canine Leishmaniasis (CanL) is a multisystemic and chronic inflammatory disease characterized by nonspecific clinical manifestations. In CanL, inflammatory cells and chemical mediators released in response to the parasite play a role in disease development and progression. Alterations on hematological parameters have been documented in CanL. These changes can also be assessed in relation to systemic inflammation caused by this disease. The circulating leukocyte counting, such as neutrophils, as well as the albumin level, are considered direct indicators of an inflammatory host environment. Several studies point to the use of biomarkers on the assistance in diagnosis and prognosis of several canine pathologies. The present study investigated the Neutrophils to Lymphocyte Ratio (NLR), Albumin to Globulin Ratio (AGR), and Neutrophils to Albumin Ratio (NAR) on systemic inflammatory response induced by Canine Leishmaniasis (CanL).Materials, Methods & Results: For this purpose, adult dogs with confirmed diagnosis to CanL were divided into symptomatic (SD, n = 33) and asymptomatic (AD, n = 20) dogs for L. infantum and control dogs (CD, n = 20). Routine hematological and biochemical parameters were determined in blood samples using a veterinary automatic hematology and biochemical analyzers. Asymptomatic dogs (AD) had a higher number of white blood cells and neutrophils (16.48 ± 4.93; 13.41 ± 3.60, respectively) in relation to symptomatic dogs (SD) (13.54 ± 5.13; 10.42± 3.69, respectively) (P = 0.015 and P < 0.0001, respectively). Neutrophils to Lymphocyte Ratio (NLR) was higher in dogs with leishmaniasis (9.45 ± 3.76) than in healthy dogs (3.39 ± 1.19) (P < 0.0001). Serum total proteins (STP) and globulins increased in CanL, while albumin and AGR decreased in CanL, when compared to CD and references values to canine species. Neutrophils to Albumin Ratio (NAR) was higher in AD and SD (5.02 ± 1.14; 4.79 ± 1.07, respectively) when compared to CD (2.36 ± 0.55) (P < 0.0001). Discussion: As reported in scientific researches, dogs with Leishmaniasis present alterations in circulating cell counts. Based on these data, we decided to expand this information using the NLR as a parameter in an attempt to better clarify the changes in these cells in CanL. We observed that NLR was increased on CanL in relation to healthy dogs, which could be a consequence of relative neutrophilia rather than lymphopenia. Neutrophils to Lymphocyte Ratio (NLR) is a biomarker that conveys information about inflammatory conditions. An elevated NLR can reflect an upregulated innate immune response, since neutrophils are effector cells of innate immunity and are involved in several acute and chronic inflammatory processes. Albumin is an acute phase protein that is considered an immune-inflammatory biomarker, which can be found reduced systemically in progressive inflammatory response. Serum total proteins (STP) and globulins were increased in CanL. These data are already well documented in CanL, which serum globulins are mainly associated with the increase of acute phase proteins, cytokines, and increase of specific antibodies to Leishmaniainfantum. Our results showed neutrophilia with hypoalbuminemia in CanL. So, in an attempt to assess the relationship of these two available markers, we used NAR calculation in order to evaluate the changes induced by CanL. In this study NAR was higher in CanL when compared to control dogs. Thus, our data indicate that NLR and NAR could be used as biomarkers in veterinary medical clinics in order to assess inflammatory profile in CanL, mainly in asymptomatic dogs. These parameters obtained from routine blood tests might be useful as cost-effective, easily accessible and helpful markers in order to distinguish the inflammatory response intensity in CanL.

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Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174418000648 ◽

2018 ◽

Vol 10 (1) ◽

pp. 88-99 ◽

Cited By ~ 18

Author(s):

N. Letourneau ◽

D. Dewey ◽

B. J. Kaplan ◽

H. Ntanda ◽

J. Novick ◽

...

Keyword(s):

Mental Health ◽

Maternal Depression ◽

Adverse Childhood Experiences ◽

Externalizing Problems ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Childhood Experiences ◽

Targeted Interventions ◽

Adverse Childhood ◽

Children’S Behaviour

AbstractAdverse childhood experiences (ACEs) of parents are associated with a variety of negative health outcomes in offspring. Little is known about the mechanisms by which ACEs are transmitted to the next generation. Given that maternal depression and anxiety are related to ACEs and negatively affect children’s behaviour, these exposures may be pathways between maternal ACEs and child psychopathology. Child sex may modify these associations. Our objectives were to determine: (1) the association between ACEs and children’s behaviour, (2) whether maternal symptoms of prenatal and postnatal depression and anxiety mediate the relationship between maternal ACEs and children’s behaviour, and (3) whether these relationships are moderated by child sex. Pearson correlations and latent path analyses were undertaken using data from 907 children and their mothers enrolled the Alberta Pregnancy Outcomes and Nutrition study. Overall, maternal ACEs were associated with symptoms of anxiety and depression during the perinatal period, and externalizing problems in children. Furthermore, we observed indirect associations between maternal ACEs and children’s internalizing and externalizing problems via maternal anxiety and depression. Sex differences were observed, with boys demonstrating greater vulnerability to the indirect effects of maternal ACEs via both anxiety and depression. Findings suggest that maternal mental health may be a mechanism by which maternal early life adversity is transmitted to children, especially boys. Further research is needed to determine if targeted interventions with women who have both high ACEs and mental health problems can prevent or ameliorate the effects of ACEs on children’s behavioural psychopathology.

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ANGIOMATOSIS (HAMARTOMATOUS HEM-LYMPHANGIOMATOSIS)

PEDIATRICS ◽

10.1542/peds.28.1.65 ◽

1961 ◽

Vol 28 (1) ◽

pp. 65-76

Author(s):

Peter J. Koblenzer ◽

Martin J. Bukowski

Keyword(s):

Blood Vessels ◽

Lymphatic System ◽

Vascular System ◽

Clinical Manifestations ◽

Body Cavity ◽

Histologic Examination ◽

Peripheral Vascular ◽

Osteolytic Lesions ◽

System A

A case is described of a diffuse, possibly generalized, abnormality of a hamartomatous nature of the peripheral vascular system. A number of cases from the literature, which also appear to belong in this category, are summarized. Histologic examination shows that lymph and blood vessels may both be involved, though this may be essentially an abnormality of the lymphatic system in which extensive venolymphatic communications occur. The clinical manifestations vary according to the site of involvement and the extent of dissemination and also according to whether the lesions are predominantly hemangiomatous or lymphangiomatous. The main features are osteolytic lesions, visceromegaly, cutaneous hemangiomas or lymphangiomas and massive effusions into any body cavity. The effusions are usually chylous, sanguineous or a mixture of both. Any or all of these features may be present in any one case. The disease frequently has its onset in childhood or adolescence and tends to be progressive. If the lesions are widely disseminated or an effusion into a body cavity is present the outlook is grave. Treatment so far has been unsuccessful. Surgery may occasionally have a place. The term angiomatosis is employed to denote this condition not only to underline its potentially extensive nature but also to avoid debate as to whether it is essentially hemangiomatosis or lymphangiomatosis.

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Occurence of post-traumatic stress symptoms, anxiety and depression in the acute phase of transient ischemic attack and stroke

10.21203/rs.3.rs-104881/v1 ◽

2020 ◽

Author(s):

Helge HO Müller ◽

Katharina Czwalinna ◽

Ruihao Wang ◽

Caroline Lücke ◽

Alexandra P. Lam ◽

...

Keyword(s):

Acute Phase ◽

Psychiatric Symptoms ◽

Depression Score ◽

Anxiety And Depression ◽

Post Traumatic Stress ◽

Stroke Patients ◽

Stress Symptoms ◽

Post Traumatic ◽

Ischemic Attack ◽

And Coping

Abstract Background Rates of post-traumatic stress symptoms, anxiety and depression are increased in patients having experienced a transient ischemic attack (TIA) or stroke several months ago. However, data of psychiatric symptoms in the acute phase within the first days after ictus are lacking. Methods In 20 patients with stroke and 33 patients with TIA we assessed disease severity by means of the NIHSS, levels of depression and anxiety by HADS, PTSD-like symptoms by PC-PTSD, quality of life (HrQoL) by SF-12, and coping style by brief COPE Inventory within the first 5 days after ictus. Results NIHSS on admission was lower in patients with TIA (0 ± 1) than in patients with stroke (3 ± 2, p < 0.001). HADS depression score was significantly higher in patients with stroke (7.0 ± 4.5) than in patients with TIA (4.9 ± 4.0). HADS anxiety score, HrQoL and coping styles were similar between TIA and stroke patients (p > 0.05). 5 and 3 of 33 TIA patients as well as 4 and 3 of 20 stroke patients had at least 11 points in the HADS anxiety and depression score respectively (p = 0.001). 2 of 33 TIA patients and 2 of 20 stroke patients had more than 2 points in the PC-PTSD (p = 0.646). We did not find consistent correlations between the NIHSS and the psychometric parameters. Conclusions Within the first five days after patients having experienced a TIA or stroke PTSD-like, anxious and depressive symptoms are more common than in the general population. As the acute psychological status after ictus is predictive for psychiatric comorbidity years later physicians should pay attention and adequately treat psychiatric symptoms already in the acute phase of stroke.

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Trypanosoma cruzi infection associated with atypical clinical manifestation during the acute phase of the Chagas disease

Parasites & Vectors ◽

10.1186/s13071-019-3766-3 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Lucia Rangel-Gamboa ◽

Lirio López-García ◽

Francisco Moreno-Sánchez ◽

Irma Hoyo-Ulloa ◽

María Elisa Vega-Mémije ◽

...

Keyword(s):

Trypanosoma Cruzi ◽

Chagas Disease ◽

Acute Phase ◽

Clinical Manifestations ◽

Chronic Phase ◽

Clinical History ◽

Skin Lesions ◽

Small Subunit ◽

Serological Tests ◽

Cutaneous Manifestations

Abstract Background Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi and is transmitted by triatomine insects. Clinical manifestations vary according to the phase of the disease. Cutaneous manifestations are usually observed in the acute phase (chagoma and Romaña’s sign) or after reactivation of the chronic phase by immunosuppression; however, a disseminated infection in the acute phase without immunosuppression has not been reported for CD. Here, we report an unusual case of disseminated cutaneous infection during the acute phase of CD in a Mexican woman. Methods Evaluation of the patient included a complete clinical history, a physical exam, and an exhaustive evaluation by laboratory tests, including ELISA, Western blot and PCR. Results Skin biopsies of a 50-year-old female revealed intracellular parasites affecting the lower extremities with lymphangitic spread in both legs. The PCR tests evaluated biopsy samples obtained from the lesions and blood samples, which showed a positive diagnosis for T. cruzi. Partial sequencing of the small subunit ribosomal DNA correlated with the genetic variant DTU II; however, serological tests were negative. Conclusions We present a case of CD with disseminated skin lesions that was detected by PCR and showed negative serological results. In Mexico, an endemic CD area, there are no records of this type of manifestation, which demonstrates the ability of the parasite to initiate and maintain infections in atypical tissues.

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Treatment of Anxiety and Depression in a Patient with Brugada Syndrome

Case Reports in Psychiatry ◽

10.1155/2014/478397 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Jasper J. Chen ◽

Rajbir S. Sangha

Keyword(s):

Brugada Syndrome ◽

Psychiatric Symptoms ◽

Medication Management ◽

Clinical Manifestations ◽

Physical Symptoms ◽

Clinical Findings ◽

Panic Attacks ◽

Anxiety And Depression ◽

Presenting Symptoms ◽

Channel Blocking

Background. Brugada syndrome is rare and has been a clinically diagnosable entity since 1992. Its clinical manifestations are highly variable, and while some patients remain asymptomatic, others endure sudden cardiac death. Initial presenting symptoms may include palpitations, seizures, syncope, and nocturnal agonal respiration. The diagnosis of Brugada syndrome relies on both clinical findings and characteristic ECG patterns that occur spontaneously or are induced by usage of sodium-channel blocking agents.Aims of Case Report. Many psychiatrists may be unaware of the possibility of medical cocontributing etiologies to physical symptoms of anxiety and depression. We present a case of a patient who was treated psychiatrically for anxiety and panic attacks and who was subsequently diagnosed with Brugada syndrome and treated medically with an implantable cardioverter defibrillator (ICD), the only treatment option demonstrated to be effective. Her psychiatric symptoms predated her diagnosis of Brugada syndrome by at least fifteen years.Conclusion. The patient's eventual diagnosis of Brugada syndrome altered the course of her psychopharmacologic medication management and illustrates the utility of a psychosomatic approach to psychiatric symptom management.

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Family process and youth internalizing problems: A triadic model of etiology and intervention

Development and Psychopathology ◽

10.1017/s095457941600016x ◽

2016 ◽

Vol 29 (1) ◽

pp. 273-301 ◽

Cited By ~ 25

Author(s):

Jessica L. Schleider ◽

John R. Weisz

Keyword(s):

Parenting Styles ◽

Internalizing Problems ◽

Mental Health Problems ◽

Family Processes ◽

Family Process ◽

Anxiety And Depression ◽

Future Research ◽

Targeted Interventions ◽

Youth Anxiety ◽

Triadic Model

AbstractDespite major advances in the development of interventions for youth anxiety and depression, approximately 30% of youths with anxiety do not respond to cognitive behavioral treatment, and youth depression treatments yield modest symptom decreases overall. Identifying networks of modifiable risk and maintenance factors that contribute to both youth anxiety and depression (i.e., internalizing problems) may enhance and broaden treatment benefits by informing the development of mechanism-targeted interventions. A particularly powerful network is the rich array of family processes linked to internalizing problems (e.g., parenting styles, parental mental health problems, and sibling relationships). Here, we propose a new theoretical model, the triadic modelof family process, to organize theory and evidence around modifiable, transdiagnostic family factors that may contribute to youth internalizing problems. We describe the model's implications for intervention, and we propose strategies for testing the model in future research. The model provides a framework for studying associations among family processes, their relation to youth internalizing problems, and family-based strategies for strengthening prevention and treatment.

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Trypanosoma cruzi DTU TcII presents higher blood parasitism than DTU TcI in an experimental model of mixed infection

Acta Parasitologica ◽

10.1515/ap-2015-0060 ◽

2015 ◽

Vol 60 (3) ◽

Cited By ~ 15

Author(s):

Helioswilton Sales-Campos ◽

Henrique Borges Kappel ◽

Cristiane Pontes Andrade ◽

Tiago Pereira Lima ◽

Alessandra de Castilho ◽

...

Keyword(s):

Trypanosoma Cruzi ◽

Acute Phase ◽

Clinical Manifestations ◽

Early Period ◽

Biological Properties ◽

Human Infection ◽

Biological Behavior ◽

Mixed Infections ◽

Specific Strain ◽

Biological Differences

AbstractTrypanosoma cruzi (Tc), the causative agent of Chagas disease, affects millions of people worldwide. One of the major characteristics of T. cruzi is related to its heterogeneity due to the variability of its biological properties, parasite growth rates, infectivity, tissue tropism, morbidity and virulence among different isolates observed during experimental or human infection. Moreover, presence of mixed infections in the same host in endemic areas is a matter of study due to its impact on clinical manifestations and disease progression. In this study, we evaluated the biological behavior of two Tc I strains AQ1-7 (AQ) and MUTUM (MT) and one Tc II strain (JG) during the acute phase of infection, in unique and mixed infections. A patent blood parasitism was detected only in mice inoculated with JG strain . In addition blood parasitism parameters (peak and average blood parasitism) were positively associated when JG and AQ strains were combined. In contrast, a negative association was observed in the JG+MUTUM group. The predominance of TcII strain over TcI strains was highlighted using the LSSP-PCR technique, which was performed in samples from hemoculture. Thus, this study showed important biological differences between different T. cruzi strains and discrete typing units (DTUs) in acute phase. Finally, we observed that blood parasitism during early period of infection seems to be more related to DTU than to a specific strain.

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